TY - JOUR
T1 - Rate and Rhythm Control Treatment in the Elderly and Very Elderly Patients With Atrial Fibrillation
T2 - An Observational Cohort Study of 1497 Patients
AU - Klamer, Thomas A.
AU - Bots, Sophie H.
AU - Neefs, Jolien
AU - Tulevski, Igor I.
AU - Ruijter, Hester M. den
AU - Somsen, G. Aernout
AU - de Groot, Joris R.
N1 - Funding Information:
JdG is supported by research grants through his institution from Abbot, Atricure, Bayer, Boston Scientific, Daiichi Sankyo, Johnson & Johnson and Medtronic. He received speaker fees/consulting fees from Atrian Medical, Atricure, Bayer, Biotronik, Daiichi Sankyo, IPPMed, Medtronic, Novartis and Servier. IIT and GAS are employed by CCN. The other authors declare no conflict of interest.
Funding Information:
Funding: This work was supported by the Dutch Cardiovascular Alliance consortium DCVA IMPRESS ( 2020B004 ) and ERC Consolidator Grant UCARE ( 866478 ).
Funding Information:
Funding: This work was supported by the Dutch Cardiovascular Alliance consortium DCVA IMPRESS (2020B004) and ERC Consolidator Grant UCARE (866478). JdG is supported by research grants through his institution from Abbot, Atricure, Bayer, Boston Scientific, Daiichi Sankyo, Johnson & Johnson and Medtronic. He received speaker fees/consulting fees from Atrian Medical, Atricure, Bayer, Biotronik, Daiichi Sankyo, IPPMed, Medtronic, Novartis and Servier. IIT and GAS are employed by CCN. The other authors declare no conflict of interest.
Publisher Copyright:
© 2021 The Author(s)
PY - 2022/10
Y1 - 2022/10
N2 - Stroke prevention and rate or rhythm control are crucial in the management of atrial fibrillation (AF). There is recent evidence for benefit of early rhythm control, yet rate control is the first choice in elderly patients. However, the efficacy and safety of rate and rhythm control in the elderly population remains largely unexplored. Therefore, we analyzed electronic health record data and investigated prescribing patterns and mortality of both strategies in elderly patients with AF. Data from patients with AF who were aged ≥75 years, used a pharmacological rate or rhythm control strategy, and visited Cardiology Centers of the Netherlands between 2007 and 2018 were extracted. Of the 1497 patients (54% female), 316 (21%) were prescribed rhythm control and 1181 (79%) rate control. Patients aged >85 years (OR: 2.28; 95% CI: 1.51-3.44, P< 0.001) and those with permanent AF (OR: 2.71; 95% CI: 1.67-4.41, P< 0.001) were more likely to receive rate control, whereas those with paroxysmal AF were less likely to receive rate control (OR: 0.42; 95% CI: 0.32-0.56, P< 0.001). After correction for relevant confounders, the mortality risk for patients using rhythm control and patients using rate control was similar (HR: 0.89; 95% CI: 0.70-1.12, P = 0.31). A more liberal approach towards prescribing a rhythm control strategy to the elderly patients with AF may be warranted and seems safe. Our data underscore the need for prospective studies to provide definite answers on efficacy and safety of rhythm control in elderly patients with AF.
AB - Stroke prevention and rate or rhythm control are crucial in the management of atrial fibrillation (AF). There is recent evidence for benefit of early rhythm control, yet rate control is the first choice in elderly patients. However, the efficacy and safety of rate and rhythm control in the elderly population remains largely unexplored. Therefore, we analyzed electronic health record data and investigated prescribing patterns and mortality of both strategies in elderly patients with AF. Data from patients with AF who were aged ≥75 years, used a pharmacological rate or rhythm control strategy, and visited Cardiology Centers of the Netherlands between 2007 and 2018 were extracted. Of the 1497 patients (54% female), 316 (21%) were prescribed rhythm control and 1181 (79%) rate control. Patients aged >85 years (OR: 2.28; 95% CI: 1.51-3.44, P< 0.001) and those with permanent AF (OR: 2.71; 95% CI: 1.67-4.41, P< 0.001) were more likely to receive rate control, whereas those with paroxysmal AF were less likely to receive rate control (OR: 0.42; 95% CI: 0.32-0.56, P< 0.001). After correction for relevant confounders, the mortality risk for patients using rhythm control and patients using rate control was similar (HR: 0.89; 95% CI: 0.70-1.12, P = 0.31). A more liberal approach towards prescribing a rhythm control strategy to the elderly patients with AF may be warranted and seems safe. Our data underscore the need for prospective studies to provide definite answers on efficacy and safety of rhythm control in elderly patients with AF.
UR - https://www.scopus.com/pages/publications/85118347478
U2 - 10.1016/j.cpcardiol.2021.100996
DO - 10.1016/j.cpcardiol.2021.100996
M3 - Review article
C2 - 34610350
SN - 0146-2806
VL - 47
JO - Current problems in cardiology
JF - Current problems in cardiology
IS - 10
M1 - 100996
ER -
SDG 3 Good Health and Well-being